You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.


Observations on the Treatment of Bipolar Disorder

Authors: Jerrold F. Rosenbaum, MD; Jennifer M. Covino, MPAFaculty and Disclosures



Bipolar disorder, which in the United States has a prevalence rate estimated at 1% to 3%,[1] presents numerous challenges for clinicians. Not only are symptoms variable (the key feature of bipolar I disorder is the occurrence of a manic episode, while bipolar II disorder is characterized by at least 1 hypomanic episode in addition to recurrent major depressive episodes[2]), but there is also the risk for relapse.

Recent research indicates that patients who spend longer periods of time in depressive episodes have a greater likelihood of relapsing to depression compared with mania and hypomania.[3] Over 90% of patients who experience a single manic episode will experience some form of relapse.[4]

There is also a high rate of comorbidity in bipolar disorder that often is difficult to treat. Studies have reported the rate of comorbid anxiety disorders as follows: 10.6% to 62.5% for panic disorder; 7.8% to 46.2% for social anxiety disorder; 3.2% to 35% for obsessive-compulsive disorder; 7% to 38.8% for posttraumatic stress disorder; and 7% to 32% for generalized anxiety disorder.[5]

Coupled with increased risk for suicide (with rates reported as high as 2% per year)[6] and issues of medication nonadherence (one the most common reasons for relapse of this condition),[7] clinicians face a number of barriers in treating this patient population.

Many patients who suffer ongoing symptoms and relapse are unable to maintain personal and professional relationships. One study investigating recovery following the first episode of a major affective disorder (in the study, 72.6% were bipolar and 27.4% had major depressive disorder with psychotic features) found that even though 98% of the patient population achieved syndromal recovery within 2 years, only 38% achieved functional recovery. Functional recovery meant that patients were able to regain the occupational and living situations equivalent to those they held prior to their episode. These results suggest that occupational functioning following an episode has a significant impact on long-term functional recovery.[8]

  • Print